HEALTHY c=j;

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THE EFFECTS OF NEIGHBORHOOD CHANGE ON HEALTH: A JOINT MEETING OF THE HCTF AND FIT CITY PHL November 20, 2019

d DELAWARE VALLEY

fJ REGlyrpc PLANNING COMMISSION

Welcoming & Opening Remarks

• Barry Seymour, Executive Director, DVRPC • Dr. Valerie Arkoosh, Chair, Montgomery County Board of

Commissioners, HCTF Co-Chair • Keri Salerno, Senior Director of Economic Inclusion, Public

Health Management Corporation, FitCityPHL Chair

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Keynote Presentations

The State of Residential Development across Philadelphia Anne Fadullon, Director of Planning and Development, City of Philadelphia The Impact of Residential Displacement on Healthcare Access and Mental Health among Original Residents of Gentrifying Neighborhoods in New York City Sungwoo Lim, DrPH, MS, Director of Research and Evaluation, Bureau of Epidemiology Services, Division of Epidemiology, New York City Department of Health and Mental Hygiene

o0 e~ HEALTHY ~ odvrpe ~dvrpc

Anne Fadullon Director of Planning and Development

Residential Development Across Philadelphia

Healthy Communities Task Force & Fit City PHL November 20, 2019

2

Philadelphia Market Conditions

12

Consecutive Years of Population

Growth

26%

Millennial Residents

71,000

New Jobs Since 2009

(Best job growth since WW II)

12,640

New Housing Units in 2018

3

4

Cost-Burdened4 Households

150K

"' -0 0 .i::. Q)

"' :, 0 I 0 ... Q) .0

E :, z

120K

90K

60K

30K

0 <30% AMI

2016: there are roughly 125,000 severely cost-burdened renters and owners in Philadelphia .

30-50% AMI

50-80% 80-120% AMI AMI

>120% AMI

■ Severely Cost-Burdened Renter Cost-Burdened Renter

■ Severely Cost-Burdened Homeowner ■ Cost-Burdened Homeowner

25% 24,000 living in poverty2 eviction filings in 2017

Condition of Housing Stock

Over

ro

88% of homes were built prior to 1980

29,000* residential properties below average exterior condition

31,000* housing units without complete kitchens

27,000* housing units without complete plumbing facilities

11,000* exterior residential property violations

42,900 5,600 Housing Authority wait list3 experiencing homelessness

5

T

/ PlriiWdptiiO ffA

•-· . I V- HII ~.,nwo.-.

...-,~o-. ■ ~IC,.,..A ■ ...,_.,a-:,,,e ■ .. v .... c ■ R-,,.10 ■ St.cty2t

-- ~ -2018 Phihtdelphia MVA

6

·­Olt,p-.Ctmc,ntl\l,lll\tt,o ~ Y~201S SMilNdby-llodc.G,oup.2010

ln1Ufliamt D•t•

0000,kn 0 0\ o Ml

- .__. 0.51·100 . ■ 101 · 1'0 ■ IS, HO

■ 2.01·2..SO ■ 151.,eo

~ ■ ,O)o,,..,

7

8

a., .. Philadelphia

Housing for Equity: AN ACTION PLAN FOR PHILADELPHIA -20\a

9

Workforce Market Rate Public Housing

Affordable Homeless

10

WEST > DISTRICT PLAN

3'~d ~ ~hiladelphia

PHILADELPHIA

2~ 35

City of Philade lphia and the

Philade lphia Housing Authority

Assessment of Fair Housing

December 23, 2016

11

10-Year Housing Goals Housing Type AMI Range Income Owner Renter Total

Preserved5 New6 Preserved5 New6

I Homeless 2,500 2,500 I

I <30% $0-25k 20,000 18,000 1,400 39,400

Affordable 30-50% $25-42k 2,000 6,000 4,200 12,200

I 50-80% $42-67k 2,000 6,000 10,000 1,400 19,400

I Workforce 80-120% $67-100k 5,500 4,000 2,000 11,500 I

I Marlmt-Rate >120% $100k+ 7,500 7,600 15,000 I

Total 29,500 17,500 34,000 19,000 100,000

Basic Systems Repair

Weatherization

Adaptive Modifications

12

• Housing our Most Vulnerable Residents • Preserving and Protecting Long-Term Affordability • Pathways to Sustainable Homeownership and Wealth

Creation • Encouraging Equitable Growth without Displacement • Encouraging Efficient and Innovative Development and

Rehabilitation to Promote Greater Housing Choice

Key Themes

Foreclosure Prevention Court

13

House our Most Vulnerable Residents

14

Preserve & Protect Long-Term Affordability

Before

15

Pathways to Sustainable Homeownership \~ • Re0 C9

QC) '1--t• • Philadelphia Neighborhood ~ "Mfljll&" Home Preservation %, Loan Program

(ycY.

16

Equitable Growth Without Displacement

17

Innovation for Greater Housing Choice

18

Implementing the Plan

19

Resources 2019-2028 New Resources: 7 _ Federal $0

10-Year Total: $581,000,000 J

Current Resources: 10-Year Total:

$5,595,500,000

Local $186,ooo,ooo

State $0

Private/Leverage $395,000,000

Federal

Local

$4,194,500,000

$749,000,000

State $92,000,000

Private/ Leverage $560,000,000

10-Y•r Total: $8,178,500,000

"-- Federal

Local

$4,194,500,000

$935,000,000

State $92,000,000

Private/ Leverage $955,000,000

20

We’re Doing It!

Home Repair Loan Program First-time Homebuyer Assistance Funding for Pilot Programs

Thank you!

Questions?

Assessing the impact of displacement on emergency department visits and hospitalizations among residents of gentrifying neighborhoods

Sungwoo Lim, Pui Ying Chan, Sarah Walters, Gretchen Culp, Mary Huynh, and Hannah Gould

November 20, 2019

Health

NYC DOHMH BUREAU OF EPIDE1MIOLOGY SERVICES

Background

• Displacement is associated with adverse health outcomes

• One of the possible drivers of displacement is gentrification – Gentrification is a process of urban development

whereby resource-deprived neighborhoods are revitalized via influx of affluent, educated residents

• However, evidence from systematic, quantitative assessments is limited

2

Study questions

1. Does displacement to poor, non-gentrifying neighborhoods increase difficulty in accessing health care and therefore increase hospital use?

2. Does displacement disrupt existing social ties, resulting in an increased level of stress and mental health (MH) issues and therefore increased MH-related ED visits/hospitalizations?

3

Methods

Identifying gentrifying neighborhoods

• Neighborhood (PUMA) level variables from 2005-2014 American Community Survey – % of college graduate in 2005 – Median household income in 2005 – Median rental price in 2005 – Growth in each of the above 3 variables from 2005 to

2014 • Principal component analysis • Gentrifying neighborhoods: low 2005 values and

fast growth • Poor, non-gentrifying neighborhoods: low 2005

values and slow growth

5

Gentrifying neighborhoods

6

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t Mu-nay Hill

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Colleg.e.grad .growth

Flu.shini,

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High 2005 value (left) vs low 2005 value (right)

Bureau of Epidemiology Services

0.3

(0

N

0

N I

(0 I

7

Gentrifying Neighborhood ■ Bedford-Stuyvesant

■ Bushwick

■ Central Harlem

■ Chinatown & Lower East Side

■ Crown Heights North & Prospect Heights

East Harlem

■ Greenpoint & Williamsburg

■ Hamilton Heights & West Harlem

Poor, non-gentrifying neighborhoods

8

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Sunnyside East Harlem Oown HtsS

Pait S lope Wuhington Hts

ChelS1!9 Bensonhurst

Sheepsh•a/ifJ¥u, h

Bayside

Colleg• g"'d~

Uppe<W..tSide Mu11ay Hill

Up?Ef Ea5t Side Riverd-ale

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B,ownsvilleB-elmont Hunts Po int

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High 2005 value (left) vs low 2005 value (right)

Bureau of Epidemiology Services

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N

0

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9

Non-gentrifying Neighborhood ■ Bedford Park, Fordham North & Norwood

■ Belmont, Crotona Park East & East Tremont

■ Brownsville & Ocean Hill

■ Concourse, Highbridge & Mount Eden ■ East New York & Starrett City

Hunts Point, Longwood & Melrose

■ Morris Heights & Fordham South

Data and Cohort Selection

• Data: 2006-2014 Statewide Planning and Research Cooperative System (SPARCS) data

• Cohort: adult (18+) with least one ED visit or one hospitalization and geocodable address every 2 years since 2006

• Excluded individuals with > 3 unique addresses per year before baseline (<1%) – Possible homeless people & people sharing the same

identifier

10

Data and Cohort Selection (2)

11

Displaced (N = 3,032) : lived in gentrifying neighborhoods in 2006 and has ever moved to a poor, non-gentrifying neighborhood

Sensitivity analysis (N = 10,300): lived in poor, non-gentrifying neighborhoods throughout

Control (N = 9,941): lived in gentrifying neighborhoods throughout

Gentrifying Neighborhood ■ Bedford-Stuyvesant

■ Bushwick ■ Central Harlem ■ Chinatown & Lower East Side

■ Crown Heights North & Prospect Heights East Harlem

■ Greenpoint & Williamsburg Hamilton Heights & West Harlem

Bureau of Epidemiology Services

Non-gentrifying Neighborhood ■ Bedford Park, Fordham North & Norwood

■ Belmont, Crotona Park East & East Tremont

■ Brownsville & Ocean Hill

■ Concourse, Highbridge & Mount Eden

■ East New York & Starrett City Hunts Point , Longwood & Melrose

■ Morris Heights & Fordham South

Variables

• Baseline (time point of displacement) – Displaced: midpoint between visit with the first

“displacement” and the previous visit – Control: average baseline date of displaced group

(12/29/2009) • Outcomes

– Rates of ED visits, rates of hospitalizations, rates of MH-related ED visits & hospitalizations

• Exposure: Displacement • Covariates

– Demographics, clinical characteristics, healthcare utilization prior to baseline, # of residential movements prior to baseline

12

Statistical analysis

• 1st step: Inverse probability of treatment weighting (IPTW) – To balance baseline characteristics between

displaced and control groups • Age at baseline • Sex • Pre-baseline # of ED visits/year • Pre-baseline # of hospitalizations/year • History of diagnosis (15 Clinical Classifications Software

diagnosis categories) • # of residential movements during the year before

baseline

13

Statistical analysis (2)

• 2nd step: negative binomial regression with IPTW & robust variance estimation • Outcome = exposure +sex + age + # of visits during

the year before baseline + # of residential movement during the before baseline +offset (log of total follow-up years)

14

Results

Cohort characteristics

• Cohort members vs. the general NYC adult population in 2010 – Higher % of women (72% vs. 54%) – Higher % of persons aged 45-64 years (37% vs.

28%) – Higher % of health insurance (93% vs. 83%) – Similar % of mental illness (22% vs. 21%) – Similar % of diabetes (9% vs. 9%)

16

Displaced residents were more likely to be men and younger

17

Before IPTW After IPTW

74%

33%

38%

65%

48%

30%

72%

35%

36%

71%

41%

39%

Female Female

Ages 25-44 yrs Ages 25-44 yrs

Ages 45-64 yrs Ages 45-64 yrs

Displaced

Staying

Bureau of Epidemiology Services

• •

23% 24%

8%

18%

3%

36%

20%

Displaced residents were more likely to move, make ED visits, and be diagnosed with MH-related conditions prior to baseline

18

Before IPTW After IPTW

Mental illness Mental illness

Moving Moving

Displaced

Staying

Bureau of Epidemiology Services

• •

Results from regression

• The cohort was followed up for average 5 years post-baseline

• Displacement vs. staying in the gentrifying neighborhoods was associated with higher rate of healthcare utilization

19

2.00

1.50 a: a:

I -~

--0

1.00 --0.95 0.90

ED Hospitalization MH visits

Post-hoc analyses

• Displaced persons were compared with those staying in non-gentrifying, poor neighborhoods and similar results were observed

• Primary reasons for healthcare utilization were different between those who were displaced and stayed – Alcohol-related visits: 10% vs. 2% – Drug-related visits: 4% vs. 0.6%

• However, we continued to find high RR associated with

displacement after taking out alcohol- and drug-related visits

20

Discussion

Summary

• Displaced persons, compared with those remaining in the gentrifying neighborhoods, had increased rates of ED visits, hospitalizations, and MH-related visits – This findings hold true when comparing with those who

stayed in poor, non-gentrifying neighborhoods

• Limitations – Homeless people might have been included in the

displaced group – Displacement might not result from gentrification

22

Implications

• Raising awareness of negative impacts of displacement potentially due to gentrification

• Justifying efforts to strengthen systems for mental health support and services, especially for those who have bene displaced

23

Current and future works

• Developing a concept map to summarize various pathways from gentrification to health – Better understanding upstream inputs – Different impacts by in-migration and out-migration

• Analyzing other data sources and other outcomes

– Housing instability and diabetes risk among people leaving the NYC public housing

– Displacement and child mortality risk among residents of NYC gentrifying neighborhoods

– Health impacts among original residents who remain in gentrifying neighborhoods

• Food mirage phenomenon – Comparisons w/ other cities

24

For more information, contact NYC DOHMH Bureau of Epidemiology Services Dial 311 or visit nyc.gov/health

Thank you.

ACTIVE BREAK Kelly McIntyre, Physical Activity Coordinator, Get Healthy Philly

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Ira Goldstein, Ph.d.

President Policy Solutions,

Reinvestment Fund

@reinvestfund

Ian Smith

Principal Ian Smith Design Group

Raynard Washington,

Ph.d.

Chief Epidemiologist Philadelphia Department

of Public Health

@Raynard_W @PHLPublicHealth

James Wright

Director of Community,

Economic, and Real Estate Development

People’s Emergency Center

@PECCaresPhilly @LancAvePhilly

Davin Reed, Ph.d.

Community Development

Economic Advisor Federal Reserve Bank of

Philadelphia

@philadelphiafed

What’s Happening in our Area?

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CLOSING REMARKS Christina Miller, Executive Director, Health Promotion Council HCTF Co-Chiar

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Next Steps

• The HCTF has had a busy 2019 and will take a brief hiatus until Summer 2020. Stay tuned for future meetings!

• Please turn in your evaluations and recycle your name badges.

• AICP CM#: 9188778 • Continue the conversation over lunch!

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HEALTHY c=j;

0dvrpc

THE EFFECTS OF NEIGHBORHOOD CHANGE ON HEALTH: A JOINT MEETING OF THE HCTF AND FIT CITY PHL November 20, 2019

d DELAWARE VALLEY

fJ REGlyrpc PLANNING COMMISSION